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Archive for May, 2008

 

S. Elizabeth Kortlander, Ph.D., Licensed Psychologist

 

How is it that a child who is full of life– animated, loud, and often precocious intellectually–can suddenly shut down in certain settings, stop any vocalizations, become “stone faced”, and even have difficulty navigating physically through her world?  A child with selective mutism can actually display such an on/off switch.  While this loss of speech may be puzzling, it is actually a loud proclamation of the intense anxiety a child with selective mutism is feeling at any particular moment.

            Selective mutism is a perplexing social anxiety disorder in which children “lose” their voice in situations that are perceived as threatening.  Thus while children with selective mutism may be perfectly comfortable with immediate family members, they may not speak in the presence of friends, extended family members, and/or neighbors.  Typically school offers a particularly challenging environment with inhibited speech exhibited either across the entire school setting or in certain situations.   Teachers and other adult “authority” figures may be especially anxiety provoking.  Along with the primary symptom of inhibited speech, children with selective mutism  often have difficulty initiating activities, especially in unstructured social time such as the play ground.  Transitions and any unexpected change in routine or personnel may also cause the child to shut down, not only verbally but behaviorally as well.  At its severest, a child with selective mutism may actually have to be physically prompted or guided to continue or start a new activity. 

            Of all the anxiety disorders, selective mutism is one of the easiest to gage in terms of the degree of anxiety or discomfort that a child is feeling at any one time.  For instance, while a child may not verbalize at a normal volume, he may at times whisper into a trusted person’s ear or even out loud.  Likewise, eye contact and a willingness to interact via gesturing or other physical signs increase as the child becomes relatively more comfortable.  The key word is relatively, since for a child to actually start talking with a developmentally appropriate voice in a previously threatening environment may require their moving slowly up through a hierarchy of discomfort.

            Successfully treating Selective Mutism involves a variety of interventions across a range of environments.  The goal is to help the child learn that the people and settings that feel scary are actually safe.  To address school issues, parents, teachers, and mental health professionals must work as a team.  The first step is education.  On the part of the mental health provider he should observe the child in the school setting (before meeting him), note the subtle cues of comfort and discomfort that the child gives in different settings, consult with the school personnel about their observations, and draw up a structured plan for helping the child to make progress.   Parents should also be educated about the disorder and its treatment.  Quite often by the time a child sees a mental health professional, the parents have tried a number of things, such as punishment for not speaking and reinforcers for speaking.  While well intended, these strategies have the unintended effect of pressuring the child to speak, which is one of the most potent ways to induce anxiety and further shut down verbalizations.   Other professionals such as speech pathologists, to rule out any other contributing factors to verbal inhibition, may also be called upon.  The mental health provider, parents, and school personnel should meet and collaborate with a plan. Simple interventions such as getting the child to school early so the parent can help transition the child into the classroom, avoiding too much eye contact when speaking to the child, and shaping questions to allow for yes/no or other brief answers may also help.  Identifying who the child feels comfortable with in the class, and even arranging play dates outside the school setting are all often part of the overall plan.  The essential component of treatment is patience which will allow for awareness and appropriate reinforcement for any steps forward.  Developmentally appropriate cognitive behavioral therapy is also useful to help the child deal with her anxiety and gain coping skills.  Parent education and guidance on how to best help their child is also critical.   Intervening at the earliest possible time is key, since selective mutism may become increasingly difficult to treat as the child matures and moves through school.  Likewise the social, academic, and emotional ramifications of being unable to communicate become increasingly debilitating with age. 

            The good news is that information about the disorder and effective treatment is growing.  With appropriate interventions and patience, selectively mute children can break their silence, and let the world know of all the talents they have to offer.

 

For more information on selective mutism please visit www.selectivemutism.org.

 

If you would like any further information on the topic of selective mutism, please contact her via her webpage at http://www.westonpsychcare.com/s-elizabeth-kortlander.html

 

 

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